Objective To explore the evaluation value of myocardial contrast echocardiography (MCE) for myocardial perfusion and prognosis in patients with acute STEMI after PCI. Methods The case data of 78 patients with acute STEMI undergoing PCI in the hospital were collected. All underwent MCE within 48h after surgery. According to MCE results, they were divided into group A (43 cases, normal perfusion filling: contrast agents filling in myocardial segments were even, complete developing), group B (20 cases, sparse perfusion filling: contrast agents filling in myocardial segments were uneven, partial developing) and group C (15 cases, defected perfusion filling: contrast agents filling in myocardial segments were defected, complete non-developing). The left ventricular function indexes [left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume ( LVESV)] in different groups were obtained by routine ultrasound and MCE at 48h, 1 month and 3 months after surgery. The incidence of major adverse cardiovascular events (MACE) in the three groups was recorded at 6, 12 and 24 months after surgery. The independent risk factors of MACE were analyzed by Logistic backward stepwise regression analysis. Results Compared with group A, LVEDV and LVESV were increased, while LVEF was decreased in groups B and C (P<0.05). Compared with group B, LVEDV and LVESV were increased, while LVEF was decreased in group C (P<0.05). Compared with group A, incidence of MACE after PCI was higher in groups B and C (P<0.05). The results of multivariate Logistic regression analysis showed that LVEDV, LVESV, LVEF and MCE results were independent risk factors of MACE in patients with acute STEMI after PCI (P<0.05). Conclusion MCE can effectively evaluate myocardial perfusion and independently predict the occurrence of postoperative MACE in patients with acute STEMI after PCI, which is conducive to prognosis of patients.